Intraocular inflammation as the main manifestation of Rickettsia conorii infection

Archimedes LD Agahan1,3, Jenice Torres1, Graciana Fuentes-P&aacute;ez1, Hernan Mart&iacute;nez-Osorio1, Antonio Ordu&ntilde;a2, Margarita Calonge11Ocular Immunology and Uveitis Unit, Institute of Applied Ophthalmobiology (IOBA), 2Microbiology Department, University of Vallado...

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Autores principales:	Ordu&ntilde;a A, Mart&iacute;nez-Osorio H, Fuentes-P&aacute;ez G, Torres J, Agahan ALD, Calonge M
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2011
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/317ffe097d414ac48519155005007522
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spelling	oai:doaj.org-article:317ffe097d414ac485191550050075222021-12-02T01:29:13ZIntraocular inflammation as the main manifestation of Rickettsia conorii infection1177-54671177-5483https://doaj.org/article/317ffe097d414ac485191550050075222011-09-01T00:00:00Zhttp://www.dovepress.com/intraocular-inflammation-as-the-main-manifestation-of-rickettsia-conor-a8352https://doaj.org/toc/1177-5467https://doaj.org/toc/1177-5483Archimedes LD Agahan1,3, Jenice Torres1, Graciana Fuentes-P&aacute;ez1, Hernan Mart&iacute;nez-Osorio1, Antonio Ordu&ntilde;a2, Margarita Calonge11Ocular Immunology and Uveitis Unit, Institute of Applied Ophthalmobiology (IOBA), 2Microbiology Department, University of Valladolid, Valladolid, Spain; 3Department of Ophthalmology and Visual Sciences, University of the Philippines, Philippine General Hospital, Manila, PhilippinesObjective: To report the clinical features and management of seven cases of intraocular inflammation caused by Rickettsia infection and review published literature.Methods: Rickettsia conorii or Rickettsia spp. infection was diagnosed based on the following criteria: (1) positive serology according to the European Guidelines, (2) titer normalization after specific treatment, and (3) complete resolution of ophthalmic disease and accompanying symptoms after antibiotic therapy.Results: Seven patients were referred for uveitis of unknown etiology. All came from regions where Mediterranean spotted fever is prevalent. One patient met the European guidelines criteria for Rickettsia spp. infection, while the other six cases met the criteria for R. conorii infection. The main symptoms were visual loss, floaters, eye redness, photophobia, and ocular pain. Predominant ophthalmic signs included vasculitis, choroiditis, vitritis, and macular edema. All patients required antibiotic treatment that resulted in the remission of the infection. Doxycycline was the first choice and the only antibiotic used to treat four patients. One patient needed ciprofloxacin as a second antibiotic after not responding to doxycycline. Two patients had doxycycline as a second antibiotic after not responding primarily to sulfonamides (which had been given after 2&ndash;3 days of doxycycline gastric intolerance); one of these patients needed ciprofloxacin as a third antibiotic.Conclusion: Intraocular inflammation can occur as the main manifestation of Rickettsia conorii or Rickettsia spp. infection. It should be considered as a differential diagnosis for uveitis especially for patients living in countries where this infection is endemic in the world. Antibiotic treatment remains effective in the management of Rickettsia infection.Keywords: intraocular inflammation, Mediterranean spotted fever, Rickettsia conorii, uveitisOrdu&ntilde;a AMart&iacute;nez-Osorio HFuentes-P&aacute;ez GTorres JAgahan ALDCalonge MDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2011, Iss default, Pp 1401-1407 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Ordu&ntilde;a A Mart&iacute;nez-Osorio H Fuentes-P&aacute;ez G Torres J Agahan ALD Calonge M Intraocular inflammation as the main manifestation of Rickettsia conorii infection
description	Archimedes LD Agahan1,3, Jenice Torres1, Graciana Fuentes-P&aacute;ez1, Hernan Mart&iacute;nez-Osorio1, Antonio Ordu&ntilde;a2, Margarita Calonge11Ocular Immunology and Uveitis Unit, Institute of Applied Ophthalmobiology (IOBA), 2Microbiology Department, University of Valladolid, Valladolid, Spain; 3Department of Ophthalmology and Visual Sciences, University of the Philippines, Philippine General Hospital, Manila, PhilippinesObjective: To report the clinical features and management of seven cases of intraocular inflammation caused by Rickettsia infection and review published literature.Methods: Rickettsia conorii or Rickettsia spp. infection was diagnosed based on the following criteria: (1) positive serology according to the European Guidelines, (2) titer normalization after specific treatment, and (3) complete resolution of ophthalmic disease and accompanying symptoms after antibiotic therapy.Results: Seven patients were referred for uveitis of unknown etiology. All came from regions where Mediterranean spotted fever is prevalent. One patient met the European guidelines criteria for Rickettsia spp. infection, while the other six cases met the criteria for R. conorii infection. The main symptoms were visual loss, floaters, eye redness, photophobia, and ocular pain. Predominant ophthalmic signs included vasculitis, choroiditis, vitritis, and macular edema. All patients required antibiotic treatment that resulted in the remission of the infection. Doxycycline was the first choice and the only antibiotic used to treat four patients. One patient needed ciprofloxacin as a second antibiotic after not responding to doxycycline. Two patients had doxycycline as a second antibiotic after not responding primarily to sulfonamides (which had been given after 2&ndash;3 days of doxycycline gastric intolerance); one of these patients needed ciprofloxacin as a third antibiotic.Conclusion: Intraocular inflammation can occur as the main manifestation of Rickettsia conorii or Rickettsia spp. infection. It should be considered as a differential diagnosis for uveitis especially for patients living in countries where this infection is endemic in the world. Antibiotic treatment remains effective in the management of Rickettsia infection.Keywords: intraocular inflammation, Mediterranean spotted fever, Rickettsia conorii, uveitis
format	article
author	Ordu&ntilde;a A Mart&iacute;nez-Osorio H Fuentes-P&aacute;ez G Torres J Agahan ALD Calonge M
author_facet	Ordu&ntilde;a A Mart&iacute;nez-Osorio H Fuentes-P&aacute;ez G Torres J Agahan ALD Calonge M
author_sort	Ordu&ntilde;a A
title	Intraocular inflammation as the main manifestation of Rickettsia conorii infection
title_short	Intraocular inflammation as the main manifestation of Rickettsia conorii infection
title_full	Intraocular inflammation as the main manifestation of Rickettsia conorii infection
title_fullStr	Intraocular inflammation as the main manifestation of Rickettsia conorii infection
title_full_unstemmed	Intraocular inflammation as the main manifestation of Rickettsia conorii infection
title_sort	intraocular inflammation as the main manifestation of rickettsia conorii infection
publisher	Dove Medical Press
publishDate	2011
url	https://doaj.org/article/317ffe097d414ac48519155005007522
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Intraocular inflammation as the main manifestation of Rickettsia conorii infection

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